This inspection took place on 10 and 11 December 2018 and was announced. We announced the inspection because the service is small and we wanted to ensure there would be someone in the office. We also spoke with staff members during the week commencing 17 December 2018. This was the first inspection of the service as a separately registered entity. The service had previously been registered jointly with one of the provider’s care homes.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults. The Grange supports people in a highly rural area of Northumberland, with an office base on the same site as one of the provider’s care homes. At the time of the inspection the service was delivering around 500 care hours per week, supporting 37 people, although not all people were actively being supported with personal care needs.

The service had in post a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Risks within the service were not always well recorded and actions to mitigate risks were not identified. Where risks were recorded these did not always reflect how care was being delivered. The provider had a safeguarding policy in place and any issues had been dealt with appropriately. The service had in place contingency plans to support people in the event of poor weather or other emergencies.

People and staff told us sufficient staff were employed to support people’s personal care needs. Care was delivered to individuals by a small number of care staff to ensure consistency. People told us they were advised if staff were going to be late. The provider did not routinely monitor the number of late calls delivered by the service. Appropriate recruitment systems were followed to ensure properly experienced and qualified staff were employed.

Medicines were not always managed effectively or safely. Care records did not always indicate how staff should support people with medicines and there was limited information about how people should be supported with creams and ointments. Staff training on the safe handling of medicines and competency checks on staff around handling medicines were not always up to date. People told us staff followed safe practices with regard to cleanliness and infection control.

Systems regarding staff training were not robust and it was not always possible to determine if training had been refreshed or updated in a timely manner. Staff told us, and records showed regular supervision and annual appraisals had been undertaken.

Some relatives had signed consent forms when it was not clear they had the authority to do so. The service did not maintain details of relatives who held Lasting Power of Attorney, to ensure only people with legal authority made care decisions. The registered manager told us she undertook an assessment of people’s needs prior to them using the service, although records relating to this were not always available. People told us they were supported to make personal choices and staff encouraged them to have a heathy diet.

People told us they were very happy with the staff and the support they received. Staff were committed to ensuring people they supported received good quality and personal support. People told us they were supported to make day to day decisions about their care. Questionnaires completed by people who used the service were extremely positive about the support they received.

People’s privacy and dignity were respected. Staff spoke knowledgably about how they promoted and encouraged people’s independence.

People told us an assessment of their needs had been undertaken prior